News Articles 151 - 160 of 160
Some patients with non-alcoholic steatohepatitis (NASH) show recurrence of fibrosis as early as six to 12 months following their transplant.
This emerged in a study at the Medical University of Vienna which compared the recurrence of liver fibrosis in 15 patients transplanted for NASH with 12 to cryptogenic cirrhosis (CC) patients after orthotopic liver transplantation (OLT) between 2004 and 2015.
The case load for OLT because of NASH was constantly increasing (two in 2004-2007 compared with nine in 2012-2015) whilst decreasing for CC (six in 2004-2007 compared with two in 2012-2015). Patient characteristics at OLT were similar, except for an older age and a higher BMI in the NASH patients.
Although post-OLT plasma lipid levels and the incidence of de-novo hypertension, diabetes, and hyperlipidemia were similar between groups, the post-transplant NAFLD fibrosis score (NFS) re-increased in the NASH group but not in the CC group (-0.1317 versus -1.3645 at 12 months post-OLT.
The post-transplant course of patients undergoing liver transplantation for nonalcoholic steatohepatitis versus cryptogenic cirrhosis: a retrospective case-control study. Unger LW, Herac M, Staufer K et al. Eur J Gastroenterol Hepatol. 2016 Dec 2 [Epub ahead of print]
A new study has concluded that the new direct-acting antivirals (DAAs) are highly effective with minimal adverse effects for the treatment of HCV in haemodialysis, and are a very important advance in HCV management.
In this retrospective study, HCV antibodies were analysed in 465 patients at two Madrid hospitals. Positive antibodies were found in 54, and, among these, 29 with genotypes 1 and 4 were treated with different DAA regimens, including combinations of paritaprevir/ritonavir, ombitasvir, dasabuvir, sofosbuvir, simeprevir, daclatasvir and ledipasvir, with/without ribavirin. The most important aetiology of chronic kidney disease involved glomerular abnormalities.
In all cases, a sustained viral response was achieved after 24 weeks, regardless of DAA regimen received. Adverse effects were not relevant and no case required stopping treatment. In 15 cases, ribavirin was combined with the DAA. In these cases, the most significant adverse effect was an anaemic tendency, which was reflected in the increase of the dose of erythropoietin stimulating agents, although none required transfusions.
Effectiveness of direct-acting antivirals in Hepatitis C virus infection in haemodialysis patients. Abad S, Vega A, Rincón D et al. Nefrologia. 2016 Nov 30 [Epub ahead of print]
Although tenofovir (TDF) was more effective at three months, there was no significant difference between TDF and entecavir (ETV) in the long-term treatment of HBV related liver cirrhosis, a new meta-analysis of studies found.
A literature search, conducted by reviewers from Beijing You'an Hospital, found significant difference of ALT norm level at three months (RR 1.43) and six months (RR 0.89), and significant difference of undetectable HBV-DNA only at three months follow-up period (RR 1.59) between TDF and ETV, but no significant difference in the long-term period. There was a significant difference between TDF and ETV in eGFR level (RR 1.601) and hypophosphatemia incidence (RR 4.008).
The efficacy and safety comparison between tenofovir and entecavir in treatment of chronic hepatitis B and HBV related cirrhosis: a systematic review and meta-analysis. Han Y, Zeng A, Liao H et al. Int Immunopharmacol. 2016 Dec 1;42: 168-175 [Epub ahead of print]
On 6th December the APPG on Alcohol Harm has launched its report on the Impact of alcohol on the emergency services.
The Frontline Battle report Download Alcohol Health Alliance The Frontline Battle.pdf reveals the full extent of the pressures and dangers alcohol related problems place on our emergency services and the impact this has on the staff who serve on the frontline.
As part of the Inquiry, the group of parliamentarians took evidence from police officers, fire crew and paramedics, and also collected written evidence.
A press release can be found below:
Abused, attacked and over stretched - Parliamentary report lays bare the impact of alcohol on our emergency services
At an event in Parliament on Tuesday 6th December a report from the All Party Parliamentary Group on Alcohol Harm revealed the full extent of the pressures and dangers alcohol related problems place on our front line emergency services.
The group of parliamentarians took evidence from police officers, fire crew and paramedics, and also collected written evidence, including extensive surveys of emergency service staff across England. Findings in the report include:
• Over 50% of police officers report that alcohol related incidents make up the majority of their workload.
• Surveys find that over 80% of police officers had been assaulted by people who had been drinking, and of those more than 20% had been assaulted six or more times.
• 59% of female police officers and 33% of male officers report sexual assault or harassment while on duty.
Ambulance and A&E departments:
• Over 70% of all attendances at A&E departments are alcohol related at weekends.
• Drunken patients regularly cause significant problems for clinical staff and other patients, with clinicians reporting that they face aggression, violence and being personally assaulted by drunken patients.
• On average alcohol related fires cost almost five times as much as other fires, and are more likely to involve fatalities.
• Fire and rescue services now rescue more people from road traffic collisions than from house fires, with drink driving a continuing problem.
The group of Parliamentarians were also told that alcohol puts a significant and damaging strain on our emergency services, and that many of these incidents were avoidable if the right action was taken.
See the report introduction for quotes from emergency service personnel – Download Alcohol Health Alliance The Frontline Battle.pdf
Fiona Bruce MP, Chair of the All Party Parliamentary Group on Alcohol Harm, said: “It should be wholly unacceptable to hear of an A&E consultant being kicked in the face, medical staff having TV’s thrown at them, or female police officers being sexually assaulted. And it’s not just emergency staff who suffer; as this report describes many other people are impacted too, from taxpayers who foot the bill, to patients who can’t be seen promptly, or worse, those innocent people killed in avoidable drunk driving accidents.”
“Urgent action, as described in this report, is needed from Government at the highest level in order to address this.”
Steve Irving, Executive Officer of the Association of Ambulance Chief Executives, said: “The ambulance service attends too many patients suffering from alcohol-related injuries or illnesses, many of which would not occur without the consumption of excess alcohol. This takes valuable resources away from patients who may be seriously ill so it is clear that more widespread safe drinking, in moderation, would significantly relieve the pressure on ambulance services and the wider health economy, especially emergency departments of local hospitals.”
“ The ambulance service also attends many alcohol-related road traffic collisions each year, some of which result in death and serious injury to members of the public. This is why AACE is actually in favour of ultimately lowering the drink driving limit to zero.”
Amongst others, the report recommendations include:
• A Government-led, cross-departmental National Strategy, to engage all of the appropriate Government Departments on a strategic level.
• Lowering the drink drive limit in England and Wales from 80mg alcohol/100ml blood to 50mg/100ml. This would reduce drink driving fatalities by at least 10%, and is supported by many motoring and roads safety charities, as well as 77% of the British public.
• Reducing the affordability of cheap and high-strength alcohol, by introducing a minimum unit price (MUP) for alcohol, and reinstating the alcohol duty escalator in order to ensure the tax system both addresses alcohol harm, and incentivises the development and sale of lower strength products.
Alcohol Concern provides the secretariat for the All Party Parliamentary Group on Alcohol Harm and welcomes the recommendations made by the report.
Joanna Simons, Chief Executive of Alcohol Concern, said: “The costs of alcohol harm to the UK are huge, not only in terms on lives lost but also through the significant impact on society and our emergency services. Alcohol costs us all, even when we’re not buying alcohol ourselves.”
“What this report highlights is the enormous pressure our emergency service staff face every day. We need the UK Government to act and take steps to implement the report’s recommendations, including lowering the drink drive limit and tackling cheap and high-strength alcohol, which we know will work in reducing alcohol-related harms and ease the strain on frontline staff.”
The report provides a full list of recommendations – Download Alcohol Health Alliance The Frontline Battle.pdf
For more information, please contact: Office of Fiona Bruce MP: firstname.lastname@example.org / Tel: 0207 219 2969
(1) Institute of Alcohol Studies. Drink driving factsheet
(2) Allsop R, (2015)., ‘Saving Lives by Lowering the Legal Drink-Drive Limit’. PACTS
In October the Hepatitis C Coalition, Public Health England and Local Government Association held a workshop on ‘Testing Times: Maintaining and Improving Public Health Testing Services.’
To view a report of the event click > here.
Enter the 2017 BJN Awards today!
The BJN Hepatology/Liver Nurse of the Year award will recognise nurses who care for and treat very unwell patients with a range of life-altering conditions and diseases. The important work within this specialty should be recognised and any nurse who has made a special impact on hepatology/liver nursing should apply or be nominated.
Many people's lives are touched by these conditions and diseases, and whether they practice in hospitals or the community, nurses will find themselves caring at some stage for such patients.
This Award will recognise an individual or team who have made a demonstrable improvement to the delivery of excellent patient care.
Entries close on 12 December 2016 so nominate a colleague today by visitng the BJN website by clicking here.
Leading representatives from the alcohol harm reduction, children's, homelessness and religious sectors have today called for action on the harm done by cheap alcohol.
43 organisations and experts have written to the Chancellor calling on him to implement targeted measures such as a minimum unit price for alcohol and increased taxes on high strength white cider, to lower the burden of cheap alcohol on our most vulnerable groups, our NHS and public services, and the economy.
Their call comes in response to a report released today by Public Health England, which finds that raising the price of the cheapest alcohol products is the most powerful tool at the Government's disposal to tackle the harm done by the cheapest alcohol.
The report, published in the Lancet, explains that alcohol is the leading cause of ill health, early death and disability amongst 15-49 year olds in England, and results in 167,000 years of working life lost. The report estimates the annual cost of alcohol harm to the UK in 2016 to be between 1.3% and 2.7% of GDP, which equates to £27billion and £52billion.
In October 2016, a review of alcohol prices by the Alcohol Health Alliance UK found an abundance of cheap, high strength drinks across the UK. Researchers were able to find products like high strength white ciders, which are predominantly drunk by dependent and underage drinkers, available for as little as 16p per unit. This means that for the cost of a standard off-peak cinema ticket it is possible to buy almost seven and a half litres of high strength white cider, containing as much alcohol as 53 shots of vodka.
Last month, a study found that, in England alone, the introduction of a 50p minimum unit price could reduce alcohol deaths by around 7,200, and reduce healthcare costs by £1.2 billion over 20 years.
Responding to the Public Health England report, Professor Sir Ian Gilmore, chair of the Alcohol Health Alliance UK, said:
"This report provides yet more evidence of the effectiveness of raising the price of the cheapest alcohol to tackle alcohol-related harm.
Increased duty on the cheapest drinks, alongside minimum unit pricing, would make a real difference to the lives of some of our most vulnerable groups and ease the burden on our health service. These measures would also lower the burden of premature mortality due to alcohol, thereby increasing economic output.
At the same time, ordinary drinkers will not be penalised. Minimum unit pricing will leave pub prices untouched, and tax on the cheapest, strongest drinks will be targeted at those drinks which are preferentially consumed by harmful and dependent drinkers".
For further information, please contact Matt Chorley, the AHA's Policy and Communications Officer, at email@example.com or on 0203 075 1726.
A new study of HBV patients shows that the protective effect against cirrhosis of being female is gradually lost with increasing age.
This multicentre study from China investigated the interaction of female gender and older age on the development of cirrhosis in patients recorded in the China Registry of HBV. A total of 17,809 chronic HBV patients were studied.
The prevalence of cirrhosis in the females increased faster than that in the males over 50 years old. Multivariate analysis showed that the increase of adjusted odds ratios for developing cirrhosis in females started to accelerate after 50 years of age: 11.19 in women versus 14.75 in men aged 50 to 59; 21.67 versus 24.4 at ages 60 to 69; and 18.78 versus 12.09 in those aged over 70.
The study authors suggest that disease progression should be monitored more closely in elderly women with chronic HBV.
Female gender lost protective effect against disease progression in elderly patients with chronic hepatitis B. You H, Kong Y, Hou J et al. Sci Rep. 2016 Nov 28;6: 37498
Two otherwise unrelated studies have testified to the efficacy and safety of the combination of simeprevir and sofosbuvir in patients with HCV.
In the US-based GALAXY study, the combination, with or without ribavirin, was efficacious and well tolerated in patients with recurrent HCV genotype 1 post-orthotopic liver transplant (1).
Thirty-three such patients without cirrhosis were randomised into three arms: Arm 1, received simeprevir+sofosbuvir+ribavirin for 12 weeks; Arm 2, received simeprevir+sofosbuvir for 12 weeks; Arm 3 received simeprevir+sofosbuvir for 24 weeks; 13 additional subjects (two with cirrhosis, 11 without cirrhosis) entered Arm 3.
Among the randomised subjects, SVR12 was achieved by 81.8% in Arm 1, 100% in Arm 2, and 93.9% in Arm 3; two subjects did not achieve SVR12: one viral relapse
(follow-up Week 4; Arm 1) and one missing follow-up Week 12 data. Five subjects had a serious adverse event, considered unrelated to treatment per investigator.
In Spain’s PLUTO study, the combination of simeprevir plus sofosbuvir for 12 weeks resulted in SVR12 rates of 100% in treatment-naïve and -experienced patients with HCV genotype 4 with or without compensated cirrhosis, and was well tolerated (2).
Forty patients received the combination for 12 weeks. Seven of the patients had compensated cirrhosis. All achieved SVR12. Adverse events, all Grade 1 or 2, were reported in 20 patients. No serious adverse events were reported and no patients discontinued study treatment. Grade 3 treatment-emergent laboratory abnormalities occurred in two patients.
Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C post-orthotopic liver transplant: the randomized GALAXY study. O'Leary JG, Fontana RJ, Brown K et al. Transpl Int. 2016 Nov 29 [Epub ahead of print]
Simeprevir in combination with sofosbuvir in treatment-naïve and -experienced patients with hepatitis C virus genotype 4 infection: a Phase III, open-label, single-arm study (PLUTO). Buti M, Calleja JL, Lens S et al. Aliment Pharmacol Ther. 2016 Nov 29 [Epub ahead of print]
The overall rate of increase in hepatocellular carcinoma (HCC) slowed between 2010 and 2012, found a nationwide US study. However, it did increase in some sub-groups such as men aged 55 to 64, and whites/Caucasians.
Researchers at Baylor College of Medicine in Texas analysed data from the US Cancer Statistics registry, which covers 97% of the population of all 50 states.
They found that the HCC incidence increased from 4.4/100,000 in 2000 to 6.7/100,000 in 2012, increasing by 4.5% annually between 2000 and 2009, but only by 0.7% annually between 2010 and 2012.
The average annual percentage change (AAPC) between 2000 and 2012 was higher in men (increase of 3.7%) than women (increase of 2.7%), and highest in 55 to 59-year-olds (AAPC 8.9%) and 60 to 64-year-olds (AAPC 6.4%).
By 2012, rates in Hispanics surpassed those in Asians, and rates in Texas surpassed those in Hawaii (9.71/100,000 vs 9.68/100,000). Geographic variation within individual race and ethnic groups was observed, but rates were highest in all major race and ethnic groups in Texas.
Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through
2012. White DL, Thrift AP, Kanwal F et al. Gastroenterology. 2016 Nov 23 [Epub ahead of print]